Indocyanine green angiography for preventing postoperative mastectomy skin flap necrosis in immediate breast reconstruction

• Published in: Cochrane database of systematic reviews 2020-04, Vol.4 (4), p.CD013280-CD013280
• Main Authors: Pruimboom, Tim, Schols, Rutger M, Van Kuijk, Sander Mj, Van der Hulst, René Rwj, Qiu, Shan S
• Format: Article
• Language: English
• Subjects: Angiography - methods; Bias; Breast Neoplasms - surgery; Breast surgery; Cancer; Coloring Agents; Female; Hematoma - epidemiology; Humans; Indocyanine Green; Mammaplasty - adverse effects; Mammaplasty - methods; Mastectomy - adverse effects; Mastectomy - methods; Necrosis - epidemiology; Necrosis - prevention & control; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Prospective Studies; Reoperation - statistics & numerical data; Retrospective Studies; Seroma - epidemiology; Surgical Flaps - blood supply; Surgical Flaps - pathology; Surgical Wound Dehiscence - epidemiology; Surgical Wound Infection - epidemiology
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD013280.pub2

Breast cancer will affect one in eight women during their lifetime. The opportunity to restore the removed tissue and cosmetic appearance is provided by reconstructive breast surgery following skin-sparing mastectomy (SSM). Mastectomy skin flap necrosis (MSFN) is a common complication following SSM breast reconstruction. This postoperative complication can be prevented by intraoperative assessment of mastectomy skin flap viability and intervention when tissue perfusion is compromised. Indocyanine green fluorescence angiography is presumed to be a better predictor of MSFN compared to clinical evaluation alone. To assess the effects of indocyanine green fluorescence angiography (ICGA) for preventing mastectomy skin flap necrosis in women undergoing immediate breast reconstruction following skin-sparing mastectomy. To summarise the different ICGA protocols available for assessment of mastectomy skin flap perfusion in women undergoing immediate breast reconstructions following skin-sparing mastectomy. We searched the Cochrane Breast Cancer Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL; Issue 3, 2019), MEDLINE, Embase, the World Health Organization's International Clinical Trials Registry Platform (ICTRP) and Clinicaltrials.gov in April 2019. In addition, we searched reference lists of published studies. We included studies that compared the use of ICGA to clinical evaluation to assess mastectomy skin vascularisation and recruited women undergoing immediate autologous or prosthetic reconstructive surgery following SSM for confirmed breast malignancy or high risk of developing breast cancer. Two review authors independently assessed the risk of bias of the included nonrandomised studies and extracted data on postoperative outcomes, including postoperative MSFN, reoperation, autologous flap necrosis, dehiscence, infection, haematoma and seroma, and patient-related outcomes. The quality of the evidence was assessed using the GRADE approach and we constructed two 'Summary of finding's tables: one for the comparison of ICGA to clinical evaluation on a per patient basis and one on a per breast basis. Nine nonrandomised cohort studies met the inclusion criteria and involved a total of 1589 women with 2199 breast reconstructions. We included seven retrospective and two prospective cohort studies. Six studies reported the number of MSFN on a per breast basis for a total of 1435 breasts and three studies reported the number of MSFN on a pe